evidence-based blog of Filippo Dibari

Posts Tagged ‘UNICEF’

UNICEF/WHO/WB: Levels and Trends in Child Malnutrition

In Over-nutrition, Under-nutrition on June 7, 2017 at 7:02 pm

source: World Bank webpage

Capture

(download)

In May 2017, UNICEF, WHO and World Bank Group released the 2017 edition of the joint child malnutrition estimates for the 1990–2016 period, representing the most recent global and regional figures. A suite of on-line interactive dashboards were developed to enable users to explore the entire time-series (1990 – 2016) of global and regional estimates of prevalence and number affected for stunting, overweight, wasting and severe wasting. These estimates are presented by various regional and income group country classifications used by various agencies including the United Nations, UNICEF, WHO and The World Bank Group.

Note: Global estimates refer to the aggregate of the UN regions.

UNICEF-WHO-The World Bank: Joint child malnutrition estimates – Levels and trends

In Over-nutrition, Under-nutrition on October 31, 2014 at 3:51 pm

from the WHO website

Since 2012 UNICEF, WHO and the World Bank have been reporting joint global and regional estimates of child malnutrition. The inter-agency team regularly revises the joint data sets and updates the global and regional trend estimates, from 1990 to the present. The estimates of prevalence and numbers for child stunting, underweight, overweight, wasting and severe wasting are derived by United Nations (UN), Millennium Development Goal (MDG), UNICEF, WHO regional and World Bank income group classifications.

In 2012 the inter-agency group derived estimates up to 2011, in 2013 up to 2012 and in 2014 up to 2013. The rationale being that country data are at maximum available from surveys conducted in the year previous to when the modelling exercise takes place.


A new UN body to combat global malnutrition?

In Over-nutrition, Under-nutrition on October 15, 2014 at 10:22 am

By Elena L. Pasquini 14 October 2014

from Devex web site

 

The United Nations is considering setting up a new body to address global malnutrition as early as next month, Devex has learned.

Tentatively called “U.N. Nutrition,” the new entity will be headed by UNICEF and the World Food Program, according to well-placed sources within civil society groups attending this week’s Committee on World Food Security, or CFS, in Rome. Over the weekend, the sources also participated in working groups ahead of the second International Conference on Nutrition — known as ICN2 — jointly led by FAO and the World Health Organization in November.

During the informal talks, the rumor circulated among attendees, Stefano Prato, managing director of the Society for International Development, told Devex in Rome.

“We had confirmation from U.N. insiders [and] also from delegates that there is a concrete plan,” he said.

Civil society groups believe the model for U.N. Nutrition could be Scaling Up Nutrition, a country-led global platform that seeks to unite governments, civil society, U.N. agencies, donors, businesses and researchers in a collective effort to improve nutrition through specific interventions — including support for breastfeeding and nutrition-sensitive approaches in areas such as agriculture or WASH.

“We are [also] quite sure that it will be based on PPPs, integrating governments and the private sector,” Prato added.

U.N. Nutrition could be launched a month from now in ICN2, and civil society organizations hope more details will emerge publicly this week so the plans are “disclosed with transparency” and CSOs are allowed to give feedback on whether “it’s the right answer to malnutrition, or if there are other [solutions].”

UN Nutrition vs. CFS

On Monday, the first session of the CFS was abuzz with gossip over the rumored new agency and how it will complement the current intergovernmental body and multistakeholder platform based in Rome.

For CSOs, the first question was which organization should take the lead in the fight against global malnutrition.

“Nutrition is not a problem of delivering, it is an issue of policies,” Prato said. “We believe the nutrition question has to be addressed through [shared] rules and regulations. That’s why we suggest a strong role for CFS.”

According to the SID official, the involvement of UNICEF and WFP says something about the direction the initiative is taking: “WFP and UNICEF are not organizations where there is a sovereign assembly, such as the FAO or WHO … programs [are] driven by donors and with also a quite restricted range of donors … It is not a context of democratic dialogue and those are not spaces for [defining] policy.”

Civil society, he insisted, wants malnutrition programs to be driven by policies rather than by donors or private sector interests.

“We don’t want this role bypassed by programs defined by donors without mechanisms of consultation and control,” Prato said. “What we fear is the establishment of mechanisms that are not legitimate and not accountable.”

In this scenario, a leading role for the private sector raise further concerns for CSOs, which believe strengthening local food systems based on the diversity of agricultural systems is the key to addressing malnutrition, instead of solutions based on delivery of products, fortification, dietary supplements or processed food.

“Clearly, big multinational corporations … are very much interested [in] that … approach,” Prato said. “What we fear is the participation of the private sector without clear rules of engagement and therefore [leading to] a conflict of interest.”

ICN2, a weak step forward?

The plans for a new U.N. body focused on nutrition is part a process that it is expected to reach its high watermark at the ICN2 in November, when FAO and WHO member states are expected to endorse Sunday’s consensus on a political declaration and framework for action to fight global malnutrition.

But according to Prato, the political declaration is “extremely weak,” as it doesn’t include tangible commitments or provide any timeframe for implementation. Moreover, the framework for action is nonbinding and there is “nothing new” in its concept.

“There is a dilution of the [centrality] of the right to food … the importance of local food systems is mentioned, but very poorly,” he said. “Above all, there are … no obligations … no control and accountability mechanisms … In short, it is fundamentally a big set of words.”

Prato would rather U.N. Nutrition stay within the framework of CFS. The SID official insisted CFS must comply with its mandate to properly address the problem of global malnutrition and argued its role should be strengthened ahead of ICN2.

Is a new U.N. body the solution to combat malnutrition? And how will it complement the current multistakeholder platform based in Rome? Please let us know your thoughts by sending an email to news@devex.com or leaving a comment below.

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UNICEF – 2013 Global: Evaluation of Community Management of Acute Malnutrition (CMAM): Global Synthesis Report

In Under-nutrition on March 29, 2014 at 5:29 am

from UNICEF web page

Executive summary

(download)

Background:

Approximately 20 million children are affected by severe acute malnutrition (SAM) worldwide – some residing in countries facing emergencies and many others in non-emergency situations. Children suffering from malnutrition are susceptible to death and disease and they are also at greater risk of developmental delays.
Treatment of SAM has evolved as a major development intervention over several decades. Alongside other partners, UNICEF works to ensure that women and children have access to services, including through timely provision of essential supplies – especially therapeutic foods for the treatment of SAM. The advent of ready to use therapeutic food (RUTF) and a community-based approach – community management of acute malnutrition (CMAM) – has made it possible to treat the majority of children in their homes.
CMAM is generally a preventive continuum with four components: 1) community outreach as the basis; 2) management of moderate acute malnutrition (MAM); 3) outpatient treatment for children with SAM with a good appetite and without medical complications; and, 4) inpatient treatment for children with SAM and medical complications and/or no appetite. A key objective of CMAM is progressive integration of all four preventive components into national health systems. By the end of 2012, governments in 63 countries had established partnerships with UNICEF, WFP, WHO, donors, and NGO implementing partners (IPs) for CMAM. The Ministries of Health (MoH) assume leadership and coordination roles and provide the health facilities.
UNICEF’s inputs for CMAM include policy development, commitment of funds, coordination, and technical support available to the MoH and other implementing partners. UNICEF has made significant investments to scale up treatment of SAM through CMAM including procurement of therapeutic foods, medicines, and equipment. UNICEF currently procures approximately 32,000 MT of RUTF annually which represents an investment of over 100 million dollars.

Purpose/ Objective:

This evaluation is the first systematic effort by UNICEF to generate evidence on how well its global as well as country level CMAM strategies have worked, including their acceptance and ownership in various contexts and appropriateness of investments in capacity development and supply components. The evaluation was conducted by a team of independent external evaluators and included comprehensive assessments of CMAM in five countries (Chad, Ethiopia, Kenya, Nepal and Pakistan) and drawing synthesized findings and recommendations based on broader research and a global internet survey targeting all countries implementing CMAM. A wide range of stakeholders, including national and international partners, beneficiaries, and donors, participated in the exercise. The resulting conclusions and recommendations are intended to strengthen UNICEF’s contributions to CMAM and to support governments, UN agencies, NGOs and other stakeholders in modifying CMAM policy and technical guidance for both emergency and non-emergency contexts.

Methodology:

The evaluation scope consists of two interrelated components. First, the evaluation undertook detailed analyses of CMAM in Chad, Ethiopia, Kenya, Nepal and Pakistan. The criteria of relevance, effectiveness, efficiency, sustainability and scaling up were applied to CMAM components and to cross-cutting issues. Data were obtained from secondary sources, health system databases, and observations during visits to CMAM intervention areas. The community perspective was analysed through collection of opinions from caretakers, extended family, community leaders, and community-based health workers in addition to stakeholders from government and assistance agencies. Quantitative data were analysed to determine whether performance targets were met and qualitative data supported the analysis. Secondly, building upon case study evidence, broader research resulted in compiled lessons, good practices and recommendations for UNICEF and partners globally. A global internet survey targeting all 63 countries implementing CMAM, helped to triangulate and validate conclusions from the five country case studies.

Findings and Conclusions:

1. Relevance of CMAM Guidance and Technical Assistance
• The CMAM approach is appropriate to address acute malnutrition, particularly to the degree that CMAM is being sustainably integrated into the national health system.
• Demand for CMAM services has increased; efficient use of community resources for prevention and identification and referral of children with MAM and SAM contributes to demand.
• National contributions to CMAM are growing but scale up (expansion) is challenged by funding constraints for regular programming and reliance on emergency funds and external sources of assistance.
• Global UNICEF and WHO guidance for SAM treatment has contributed to development of national guidelines which offer high value in promoting district ownership. However, lack of agreement on the best approach to address MAM has contributed to inconsistency among countries for MAM management and concomitantly, prevention of SAM.
• Global and national guidance is generally adequate for treatment protocols but lacking or fragmented regarding: planning and monitoring, integration of CMAM, equity and gender, community assessment and mobilization, and MAM management.
• Technical support has resulted in significant gains in process, coverage and outcomes; creation of parallel systems is not sustainable and slows national ownership.
• Within UNICEF overall, there has been effective support for fund mobilization, emergency nutrition response, and supporting nutrition protocols; expansion of regional roles is important to meet national technical assistance needs.
• Capacity development has significantly promoted quality of services […]

2. CMAM Effectiveness and Quality of Services

3. Promoting Equity in Access

4. Progress and Issues related to National Ownership

5. Efficiency – Costs, Supply and Delivery of RUTF

6. Sustainability and Scaling Up (Expansion of CMAM)

[see Executive Summary for more information]

Recommendations:

Overall, the evaluation recommends that UNICEF continue to promote and support CMAM as a viable approach to preventing and addressing SAM, with an emphasis on prevention through strengthening community outreach and integrating CMAM into national health systems and with other interventions.

Ownership and Integration, Strategy and Policy, Guidelines
• UNICEF should continue to work with governments, WFP, WHO, IPs, and other stakeholders to secure a common understanding on the most effective means of addressing MAM in order to unify approaches, to strengthen community-based preventive measures, and to prevent SAM and relapses into SAM.
• Establish a guideline or framework for integration of CMAM into the health system and with other interventions that is useful at national level when based on capacity assessments and integrated with national health, nutrition and community development strategies.
• Facilitate coordination and technical support at regional/national level to expand or develop national CMAM guidelines as CMAM is integrated with other interventions such as IYCF.

Performance and Quality of Services
• Strengthen community outreach by ensuring adequate investment in CMAM awareness raising activities and their integration with outreach for other public health interventions.
• Decentralize nutrition information systems to strengthen data collection and analysis at district level supporting and reinforcing the MoHs’ lead role and joint accountability among the MoH and partners for improving quality.
• Define a standardized monitoring system to assess the quality of the CMAM services to inform the MoH, UN partners, IPs and other stakeholders where more capacity is needed.

Equity in Planning and Coverage
• Strengthen planning for CMAM through conducting community assessments, and greater use of joint integrated results-based planning exercises and mapping information […].

Mobile phone technologies to improve the prevention and treatment of malnutrition?

In Under-nutrition on August 23, 2012 at 8:56 am

Source: Rapid SMS – http://www.rapidsms.org/

In 2011, WHO reports:

The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe.

A powerful combination of factors is driving this change. These include rapid advances in mobile technologies and applications, a rise in new opportunities for the integration of mobile health into existing eHealth services, and the continued growth in coverage of mobile cellular networks.” (download the entire doc)

(To learn more about m-Health, read this paper from the WHO Bulletin: Point of care in your pocket: a research agenda for the field of m-health)

The same WHO document mentions a wide range of  applications, but regretfully does not include the treatment or the prevention of malnutrition, although the potential is there. These are few examples:

  • In Kenya, in 2009, the Millennium Villages Project and the Columbia University looked into the use of SMS to support the community-based management of acute malnutrition in children under five. The pilot study concludes that “an
 SMS
 based
 approach,
 using
 a
 system
 like
 ChildCount,
 can
 lead
 to
 improved
 maintenance
 of
 child‐specific
 anthropometric 
records
, which 

effectively 
help in 
monitoring 
a 
community’s
 health”
 (see the entire doc)
  • In Malawi, more recently, “UNICEF deployed SMS to address serious constraints within the national Integrated Nutrition and Food Security Surveillance (INFSS) System, which was facing slow data transmission, incomplete and poor quality data sets, high operational costs and low levels of stakeholder ownership.  Health workers now enter a child’s data, and through an innovative feedback loop system, Rapid SMS instantly alerts field monitors of their patients’ nutritional status. Automated basic diagnostic tests are now identifying more children with moderate malnutrition who were previously falling through the cracks.  This system also increased local ownership of the larger surveillance program through two-way information exchange.  Operational costs for the Rapid SMS system are significantly less than the current data collection system. The Government of Malawi is considering a national scale-up later this year” (read more here)
  • In the last 2 years, the same organization (Rapid SMS) has successfully piloted in Ethiopia a RUTF stock reporting and request system. This has the potential for improving the communications of stock levels and requests up the supply chain and consequently for avoiding supply breaks (more info here at page 42, and here)
  • WFP focuses on the prevention and treatment of moderate acute malnutrition and has also been involved with innovations using cash/vouchers and SMS for monitoring the implementation of programmes and for monitoring cases of malnutrition (read more at page 24 of this document)
  •  In 2011, UNICEF and Valid International undertook a “Global Mapping Review of Community-based Management of Acute Malnutrition” (with a focus on Severe Acute Malnutrition). In countries of interest, the same document suggests a review of innovative technologies to improve information flow to national level. Those include the use of Rapid SMS to improve timeliness and quality of reporting.  “Many countries have started or are recommending use of Rapid SMS“, because “the large number of centres makes compilation & transmission difficult”. For this reason, moving “towards Rapid SMS to improve transmission” is crucial.

Some of the organizations with promising capacities to design SMS platforms, and helping in fighting malnutrition, are listed here:

– – –

Note that:

the Forum on Community-based Management of Acute Malnutrition will be preparing a more detailed Technical Brief on the subject of M-health and E-health in the coming months.

Feel free to contact the Forum, if you are interested in m-health & nutrition, or in any other aspect related to Community-management of Acute Malnutrition.

– – –

Question: you know any other experience in this area of nutrition and m-health? Worth reporting on this blog? Please, share that: leave a comment (down here), or contact me.

– – –

NB: You wish to follow up this or other topics from this blog? Type your email in the rectangle at the bottom/right side of this page.

Context-specific choice of food aid items (USAID)

In Under-nutrition on August 12, 2012 at 10:22 am


(click directly on the flowchart for an enlarged view)

In a recent document (2011), USAID, in collaboration with the UN Global Nutrition Cluster, UNHCR WFP and other organizations, suggest which type of programme and food commodities are more adequate.

However, it was concluded that there is no one food product that can meet every kind of programming goal, and no one programming approach that fits all needs.

The same panel  developed decision trees and few flow charts to help policy makers and donors in taking more informed decisions about programmes and choice of food-products.

The original program guidance is available here, whereas another version of the same, visible above, was adjusted in one chapter of my PhD thesis.

Finally! Everything, really everything, about treatment of undernutrition (CMAM). In just-one-click-away, comprehensive, interactive, open-access, website.

In Under-nutrition on July 10, 2012 at 10:42 am

A new electronic forum improves the management of acute malnutrition. Worldwide.

In this area of humanitarian intervention, CMAM is the acronym mostly used: Community-based Management of Acute Malnutrition.

The CMAM forum not only hosts e-discussions about this topic, but also collects all the key documents endorsed by the WHO, other UN agencies, national and international NGOs. Otherwise scattered around, in their web sites.

World experts in this field (Andre’ Briend, and Mark Myatt among them) support this forum. Therefore, the target consists of practitioners rather than the general public.

The main focus list of the e-forum includes:

  • malnutrition and HIV/AIDS
  • malnutrition and infants, children, adolescents and adults, whose specificities are treated separately
  • malnutrition and health systems in the individual countries
  • evidence for action aiming policy-making, advocacy, support in the area of malnutrition treatment
  • product development for malnutrition rehabilitation
  • current research and existing evidences about most of the topics mentioned above
The web site has important tools:
  • you are interested in CMAM in a specific country? Visit the country section of the CMAM web forum
  • you wish to receive notices about meetings, conferences, trainings? You want to ask questions, learn how to calculate case loads, or simply follow up other people’s questions? Create your website account (for free)
  • you are interested in the latest evidence-based documents or the current state of research? Visit the related section of the forum
  • you can also contribute sharing, with the other forum members, the lessons learnt from your community-based feeding programme

This important forum was conceived thanks to the effort of many organizations. However, the realization was led by Valid International and Action Against Hunger.

If you find the CMAM forum interesting, do not hesitate to re-blog this post, or forward the link of the forum to relevant people.

If you have some constructive criticism or ideas to improve this new important tool, I encourage you to contact its coordinators: Nicky Dent and Rebecca Brown (contacts): I promise that they will be extremely happy to hear from you…

Malnutrition and gender equality in India

In Under-nutrition on April 30, 2012 at 8:56 am

: 31/ott/2007

“KOLARAS, India, 30 October 2007 — When nine-month-old twins Devki and Rahul were brought by their mother to the Nutrition Rehabilitation Centre in Kolaras — located in the Indian state of Madhya Pradesh — Rahul was a normal weight and size for his age, yet his sister Devki weighed just over half of what she should have. Devki’s condition was the result of severe malnutrition.

“Both babies showed such varied weight and health that doctors suspected less food was given to Devki, a common occurrence in some areas of India where boys are often given more attention than girls.

“According to a UNICEF report, half of the world’s undernourished children live in South Asia. In India, 30 per cent of children are born with low birth weight and almost 50 per cent remain underweight by the age of three.

“One of the Millennium Development Goals is to eradicate extreme poverty and hunger by 2015, which would mean halving the proportion of children who are underweight for their age. UNICEF has warned that the world is not on track to meet that goal.”

To read the full story, visit:http://www.unicef.org/infobycountry/india_41484.html

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